CNOR Anesthesia and Sedation Principles 4 — Questions and Answers
Question 1: A patient undergoing general anesthesia develops masseter muscle rigidity immediately after succinylcholine administration. The perioperative team should:
- Proceed with intubation and monitor
- Suspect malignant hyperthermia and prepare dantrolene (Correct answer)
- Administer additional succinylcholine
- Administer neostigmine to reverse paralysis
Correct answer: Suspect malignant hyperthermia and prepare dantrolene
Masseter spasm following succinylcholine is a potential early sign of malignant hyperthermia and warrants immediate preparation for MH treatment protocol.
Question 2: Which ASA physical status classification applies to a patient with well-controlled Type 2 diabetes and hypertension on medications?
- ASA I
- ASA II (Correct answer)
- ASA III
- ASA IV
Correct answer: ASA II
ASA II indicates a patient with mild systemic disease that is well-controlled and not functionally limiting.
Question 3: The perioperative nurse should recognize that nitrous oxide is CONTRAINDICATED in patients with:
- Controlled hypertension
- Pneumothorax or bowel obstruction (Correct answer)
- Mild asthma
- Type 1 diabetes
Correct answer: Pneumothorax or bowel obstruction
Nitrous oxide diffuses into closed gas-filled spaces faster than nitrogen exits, expanding volume and increasing pressure in pneumothorax or bowel obstruction.
Question 4: During a procedure under moderate sedation, the patient's ETCO2 rises to 65 mmHg. The nurse should:
- Document and continue monitoring
- Increase oxygen flow rate only
- Stimulate the patient and reduce sedation depth (Correct answer)
- Administer sodium bicarbonate
Correct answer: Stimulate the patient and reduce sedation depth
Rising ETCO2 indicates hypoventilation; stimulating the patient and reducing sedation depth addresses the cause of inadequate respiratory drive.
Question 5: Which of the following is the MOST appropriate position to prevent aspiration during induction of general anesthesia in a patient with a full stomach?
- Trendelenburg with left lateral tilt
- Supine with a pillow under the head
- Reverse Trendelenburg (head up) (Correct answer)
- Left lateral decubitus
Correct answer: Reverse Trendelenburg (head up)
Reverse Trendelenburg (head-up) positioning reduces gastric pressure against the lower esophageal sphincter, decreasing aspiration risk during rapid sequence induction.
Question 6: When dantrolene is administered for malignant hyperthermia, what is the initial recommended dose?
- 0.5 mg/kg IV
- 2.5 mg/kg IV (Correct answer)
- 5 mg/kg IV
- 10 mg/kg IV
Correct answer: 2.5 mg/kg IV
The initial dose of dantrolene for malignant hyperthermia is 2.5 mg/kg IV, repeated every 5 minutes as needed up to 10 mg/kg.
Question 7: A perioperative nurse notes that a patient's temperature has risen to 39.8°C and ETCO2 is 78 mmHg during an otherwise routine procedure. These findings together suggest:
- Fever from surgical site infection
- Malignant hyperthermia (Correct answer)
- Mild hyperventilation
- Hypothyroid crisis
Correct answer: Malignant hyperthermia
The combination of rising temperature and elevated ETCO2 (reflecting increased CO2 production from hypermetabolism) are classic early signs of malignant hyperthermia.
CNOR Anesthesia and Sedation Principles 4
A patient undergoing general anesthesia develops masseter muscle rigidity immediately after succinylcholine administration.
The perioperative team should: